Monday 26 November 2007

Complicated case

A patient with multiple small strokes (mainly on prietal lobes and frontal lobes) was admitted to my ward. Talking to my supervisor we agreed that the patient presented a mixture of Parkinsonism (patient couldnt stop herself during walking and need to remind the patient to "plan ahead" during transfers or negotiating obsticles during gait), cerebellar ataxia (ataxic gait, central vestibular dysfunction evidenced by occular nerve pulsy, nystagmus and symptoms of dizziness), and frontal lobe behaviors (lack of insigt, very impulsive).However, she ambulated inderpendently (poor balance, but adequate saving response, she walked like she was drunk-she said she felt like she was on a boat when she walked). I had no idea where and how to start to treat this lady. Functionally,she was fine because she doesnt need any assistance. But her gait movement was really astonishing...The treatment I gave her was education on how to rise from floor and I gave her ankle weights to practice walking with. The theory behind using ankle weights was weights would reduce ataxia. Result of 6 minute walk test showed her improvement (from 28 to 16 seconds). But still, I would never feel that I did a good job because quality of her gait was really poor. I wondered if any neuro out patient would be interested to treat her because her functional level is very high...What is your suggestion? where can I go from here? do I just discharge her and offer her some nonspecific community class to attend?

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